Smallpox vaccine -- say yes to it, or no?

'Should I get vaccinated against smallpox?" It's a question many have asked me.

Currently the U.S is gearing up to vaccinate the entire population as a protection against bioterrorism. But before you say "yes" or "no" to smallpox vaccine, it would be wise to search the crystal ball to find the answer.

Some people believe that a previous vaccination provides lifetime protection. But immunity normally lasts only three to five years.

Smallpox is a contagious disease and throughout history it has killed millions of people. Its first symptom is a high fever followed by a climactic blistering rash. Eventually pus-filled blisters crust over and scar. For one-third of its victims, the disease is lethal.

LIVE VIRUS

U.S. health authorities plan to initially vaccinate the military, medical workers and other important personnel. Then make the vaccine available to the remaining population.

But smallpox vaccination is not like most injections. Rather, a small forked needle is dipped into a bottle of vaccine. The skin is then pricked about 15 times in a small area of the upper arm. If the vaccination is successful, a pus-filled area develops that eventfully scabs over and becomes a scar.

Smallpox vaccine is manufactured from a live virus called vaccinia which is related to smallpox. Since it's a live virus, people who have been vaccinated shed the virus for up to 19 days during which time it's possible to infect others.

A report from Harvard states that in the 1960s, for every 100,000 Americans vaccinated for the first time, there were two to six cases of transmission. To decrease this risk, the site of injection should be covered with gauze until the area has healed.

Normally, vaccination is followed by a slight fever, soreness and swollen glands in the armpits. The Harvard report says that about one in 1,000 people will suffer from serious complications such as myocarditis, an infection of the heart, that one in 50,000 could have a life-threatening reaction and one or two in a million will die.

Researchers admit that these statistics are old ones. Now that more effective medical care is available, the number of life-threatening reactions may be fewer. But it's a whole new ball game, and what might and might not happen remains debatable.

In Canada, smallpox vaccine is currently available for the military, but not for the general population. The question for the general public is, when supplies are accessible, should you agree to be vaccinated? This is a difficult question to answer.

People should say, "thanks, but no thanks" to the vaccine if they suffer from skin conditions such as eczema, atopic dermatitis or unhealed skin lesions such as shingles.

Strike your name off the list if you have AIDS or other diseases associated with a weakened immune system. It's also contraindicated if you're pregnant, planning pregnancy in the next month, acutely ill, less than one year in age, over 65, breast feeding or using steroid eye drops.

For others, it can be a "damned if you do, damned if you don't" situation. For instance, do you want to take the risk of dying? Researchers at the Rand Corporation in the U.S. have predicted that if 60% of the U.S population is vaccinated, it will result in 500 deaths. So without a specific threat of an imminent terrorist attack, vaccination makes no sense.

PROLONGED CONTACT

Should you decide against smallpox vaccination, all is not lost if attack occurs. People would become contagious only after symptoms appear in about two weeks. Moreover, to become infected you need prolonged and direct contact with the virus since smallpox is not easily spread by air or casual contact.

This provides a moment of opportunity. In the event of direct contact with a smallpox victim, the use of vaccination within three days usually prevents smallpox. And even vaccination within seven days decreases the severity of an attack should it occur. But would there be sufficient personnel to immunize the population at that time?

So when smallpox vaccination becomes available for everyone, get out your crystal ball and take a long, hard look. And if you come up with the absolute answer, let me know.